Compliance with Recommendations for Prevention and Detection of Controlled-substance Diversion in Hospitals

Steven R. McClure; Brian C. O'Neal; Dennis Grauer; Rick J. Couldry; Allison R. King

Am J Health Syst Pharm. 2011;68(8):689-694.

Conclusion

The results of a survey of directors of pharmacy at a sample of U.S. institutions (hospitals that had pharmacy residency programs or were UHC members) suggest wide variation in facilities' use of recommended practices for the prevention and detection of controlled-substance diversion.

1 2 3 4 5

Next Section

The authors have declared no potential conflicts of interest.

Table 1. Demographic Characteristics of Survey Respondents (n = 135)
Characteristic	No. (%) Respondents
Characteristic	Hospitals With 1–399 Beds (n = 59)	Hospitals With ≥400 Beds (n = 76)
Hospital setting^a
Rural (population ≤50,000)	16 (27)	2 (3)
Urban (population >50,000)	43 (73)	74 (97)
Type of institution^a
Private, for-profit	1 (2)	5 (7)
Private, not-for-profit	34 (58)	61 (80)
State or government	24 (41)	10 (13)

^aSignificant difference between small and large hospitals (p < 0.05).

Table 2. Compliance With Selected Recommended Practices for Diversion Detection and Prevention^a
Practice	No. (%) Respondents Following Recommendation		p
Practice	Hospitals With 1–399 Beds (n = 59)	Hospitals With ≥400 Beds (n = 76)	p
Pharmacy
Witness and documentation required for wasting of controlled substances	57/59 (97)	72/76 (95)	>0.05
If an expired-returns company is used, DEA form 222 provided by company is reconciled against central pharmacy vault inventory	48/54 (89)	62/71 (87)	>0.05
Audit of controlled substance purchases against products added to pharmacy inventory performed at least quarterly	50/58 (86)	64/76 (84)	>0.05
Automated vault for storage of controlled substances used	44/59 (75)	73/75 (97)	0.001
If CSOS not used, log of DEA form 222 kept to ensure all are accounted for^b	34/43 (79)	52/58 (90)	>0.05
Individual who submits a controlled-substance purchase order not responsible for receiving the order	43/59 (73)	66/76 (87)	0.049
Use and waste of multidose vials of controlled substances audited	39/57 (68)	58/74 (78)	>0.05
Discrepancies reviewed by individual not routinely involved in controlled-substance handling	40/59 (68)	55/75 (73)	>0.05
Person-to-person transfers of controlled substances audited, including transfers to nonautomated storage areas	48/59 (81)	46/75 (61)	0.014
Cameras directed at controlled-substance storage areas	32/58 (55)	54/74 (73)	0.043
Cameras directed at storage areas for high-cost noncontrolled medications	18/56 (32)	30/76 (39)	>0.05
Purchases periodically reconciled against dispensings for high-cost noncontrolled medications	14/58 (24)	32/76 (42)	0.043
Personal belongings banned from drug storage areas	14/59 (24)	28/76 (37)	>0.05
Packaging of high-cost noncontrolled medications defaced to inhibit diversion and resale	1/59 (2)	5/76 (7)	…^c
Operating Rooms
Controlled substances dispensed for an OR case always reconciled by pharmacy against products documented as administered or returned to the pharmacy for wasting	26/59 (44)	48/76 (63)	0.036
Controlled substances not used in an OR case returned to the pharmacy for wasting	12/59 (20)	43/76 (57)	0.001
Nursing Units
Decentralized ADMs used for controlled-substance distribution	55/59 (93)	76/76 (100)	…^c
ADM discrepancy resolution explanations "always" or "sometimes" investigated for validity	54/55 (98)	70/76 (92)	…^c
Use of system capable of electronically identifying discrepancies between central pharmacy vault withdrawals and nursing unit-based ADM receipts	51/55 (93)	74/76 (97)	…^c
Use of "blind" count (ADM user forced to enter inventory count when accessing a pocket)	51/56 (91)	66/75 (88)	>0.05
ADM discrepancies analyzed to identify individuals most frequently involved in discrepancies	38/57 (67)	55/76 (72)	>0.05
ADM stock outages investigated for potential diversion	34/56 (61)	43/75 (57)	>0.05
Biometric fingerprint scan used for ADM access	34/59 (58)	50/76 (66)	>0.05
Locking cases used to secure non-PCA controlled-substance infusion containers while being administered	20/58 (34)	27/74 (36)	>0.05
If diversion detection software used, flagged individuals are "always" or "sometimes" investigated for potential diversion	45/51 (88)	71/72 (99)	…^c
Diversion detection software flags users for controlled-substance ADM transaction counts significantly above peer group mean	40/58 (69)	66/76 (87)	0.018
Alert (e-mail, voice mail, pager) sent to pharmacy leaders when a specified ADM per-transaction threshold exceeded	14/53 (26)	25/71 (35)	>0.05

^aFor fractional data, numerator denotes number reporting use; denominator denotes number answering survey item. DEA = Drug Enforcement Administration, CSOS = controlled-substances ordering system, OR = operating room, ADM = automated dispensing machine, PCA = patient-controlled analgesia. ^bNot applicable to 29 institutions that use electronic systems other than CSOS. ^cData limitations precluded statistical analysis.

Table 3. Diversion Detection Software
Software Source	No. (%) Respondents
Software Source	Hospitals With 1–399 Beds (n = 41)	Hospitals With ≥400 Beds (n = 65)
Vendor of automated distribution software	25 (61)	31 (48)
Pandora Data Systems (Scotts Valley, CA)	8 (20)	15 (23)
Rx Auditor (Medacist Solutions Group, Cheshire, CT)	4 (10)	12 (19)
System developed in institution	2 (5)	3 (5)
Other	2 (5)	4 (6)

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

Return to Article

Post as:

processing....

Compliance with Recommendations for Prevention and Detection of Controlled-substance Diversion in Hospitals

Conclusion

Comments

Most Popular Articles

What to Read Next on Medscape

About

Membership

Apps

WebMD Network

Editions

Compliance with Recommendations for Prevention and Detection of Controlled-substance Diversion in Hospitals

Conclusion

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

Most Popular Articles

What to Read Next on Medscape

Recommended Reading

Drugs Related to null

Most Popular Articles

Email This

Find Us On

About

Membership

Apps

WebMD Network

Editions